Should RaDonda Vaught Have Her Nursing License Reinstated?

[Nurse Beth]

RaDonda Vaught Seeking Reinstatement of Nursing License

TN state nursing board's 2021 decision to revoke her nursing license will be appealed in court on Tuesday, March 28. If the appeal is successful, she will face a retrial before the Tennessee Board of Nursing.

Nursing boards generally make decisions regarding the reinstatement of nursing licenses based on various factors, including the nature and severity of an offense, the rehabilitation efforts of the individual, and their ability to practice nursing safely and competently.

If RaDonda Vaught has completed the requirements (if any) and demonstrated that she could meet the standards of safe and competent nursing practice, then it may be possible for her to have her RN license reinstated. However, this decision ultimately rests with the state nursing board.

Background

Most of us recall the RaDonda Vaught case in 2017 because it involved a fatal medication error, and she was charged with reckless homicide for the mistake. The decision to prosecute her made history because it set a precedent for criminalizing medical errors.

On December 26, 2017,  RaDonda Vaught, a 35-year-old RN, worked as a "help-all" nurse at the Nashville, Tennessee-based Vanderbilt University Medical Center. She was sent to Radiology Services to administer VERSED (midazolam) to Charlene Murphey, a 75-year-old woman recovering from a brain injury and scheduled for a PET scan.

Charlene Murphey was experiencing anxiety, and her provider ordered Versed, a sedative,  to help her through the procedure. RaDonda entered the letters "ve" for Versed (the brand name) in the automated dispensing cabinet (ADC) search field.

No matches populated the screen under the patient's profile, so RaDonda used the ADC override function and again entered "ve," this time mistakenly selecting vecuronium.

Vecuronium is a neuromuscular blocking agent, and patients must be mechanically ventilated when administered vecuronium. RaDonda reconstituted the drug and administered what she thought was one mg of Versed.

Unaware of her mistake, RaDonda left the patient unmonitored and went on to her next help-all assignment in the ED to conduct a swallow test.

Charlene Murphey was discovered about 30 minutes later by a transporter who noticed she wasn't breathing. She had sustained an unwitnessed respiratory arrest and was pulseless. She was coded, intubated, and taken back to ICU but was brain-dead and died within twelve hours.

Charges and Convictions

Legal System

On February 4th, 2019, RaDonda was indicted and arrested on charges of reckless criminal homicide and impaired adult abuse.

On May 13, 2022, she was found guilty of criminally negligent homicide and gross neglect of an impaired adult, and sentenced to 3 years of supervised probation.

Board of Nursing

On September 27, 2019, the TN Department of Health (Nursing Board) reversed its previous decision not to pursue discipline against the nurse and charged RaDonda Vaught with:

• unprofessional conduct,
• abandoning or neglecting a patient, and
• failing to document the error.

On July 23, 2021, at the BON disciplinary trial, the Tennessee (TN) Board of Nursing revoked RaDonda Vaught's professional nursing license indefinitely, fined her $3,000, and stipulated that she pay up to $60,000 in prosecution costs. 

Controversial

Many opposed RaDonda Vaught being charged with a crime, including the American Association of Critical Care Nurses (AACN), the Institute of Safe Medicine Practice (ISMP), and the American Nurses Association (ANA).

If nurses fear reporting their errors for fear of criminal charges, it discourages ethical principles of honesty.

But should RaDonda be allowed to practice nursing again?

The (ISMP) felt strongly that revoking her license was a travesty and that the severity of the outcome wrongly influenced the decision. Contributing system errors were minimized, and RaDonda Vaught became the scapegoat, while Vanderbilt escaped full notoriety.

The ISMP said RaDonda displayed human error and at-risk behaviors but not reckless behavior. She did not act with evil intent and is a second victim of a fatal error. In a Just Culture, discipline is not meted out for human error.

Do you think RaDonda Vaught should be allowed to practice nursing again, and why or why not?

Thank you for your thoughts!

[Wuzzie]

KalipsoRed21 said:

You don't need a policy because you are a 2 year old nurse? Sorry, we all need lots of freaking policies until we know what we are doing. A 2 year old nurse doesn't know a lot.

She didn't read the 5 warnings on the Omnicell. She didn't read the label on the vial. She didn't read the top of the vial when she stuck the needle in it. She "didn't read" the gun application form where she checked the box that said she wasn't under indictment for anything. What makes you think she'd read the policy?

KalipsoRed21 said:

To me, she didn't demonstrate complete negligence, she had the ethical wherewithal to report her error to help her patient.

Again, she was found out by another nurse. Nothing ethical about it. 

[klone, MSN, RN]

Right, considering all of her actions in total, there is no reason to believe she would have self-reported that error and not covered it up. She reported it only because multiple people already knew it had occurred.

[CrunchRN, ADN, RN]

Nope. Time to find another career path.

[KalipsoRed21, BSN, RN]

Well I haven't read an article regarding this incident that has stated that several other people knew she made an error so she had to tell on herself. But that would be worth reading.

Again I would say that I have seen doctors refuse error ad nauseam even when presented with irrefutable proof. So someone saw her make an error and she then had to take action. She still could admit she made an error, that's a lot further than many people can go.

[Wuzzie]

KalipsoRed21 said:

Well I haven't read an article regarding this incident that has stated that several other people knew she made an error so she had to tell on herself. But that would be worth reading.

You need to read the TBI and CMS reports then. You'll likely have a different viewpoint once you have the actual facts not what you've read on social media. 

KalipsoRed21 said:

So someone saw her make an error and she then had to take action. She still could admit she made an error, that's a lot further than many people can go.

She couldn't very well deny it given her charge nurse was holding the evidence in her hand. There was no honor here. No high road. Just a nurse without the sense God gave a turnip. Her subsequent behavior proves that.

[Hoosier_RN, MSN]

KalipsoRed21 said:

we can find some sort of work for a nurse who made a deadly drug error especially when she behaved ethically by reporting her error.

The only reason that she was "ethical" and self reported was that another nurse caught it and told her that she was going to report it. RV admitted in her testimony that was the only reason that she reported the error. Kinda changes the perspective a bit

[HiddenAngels]

5 Rights Period!

When the Pyxis/Omnicell alerted you about the med "RED FLAG"

IF you've given that med before and you're reconstituting it shouldn't you be AWARE.  

Walking away after administering the medication, I mean come on.

>>>>>>Lastly, someone died that didn't have to die.<<<<<<

Where's your humility, decency, accountability.

I'm not punishing her all over again but I WOULD NOT want to go get my license back, show up for work, and have people not trust me or the profession. I just wouldn't.  I couldn't.

[FiremedicMike, BSN, RN, EMT-P]

KalipsoRed21 said:

You don't need a policy because you are a 2 year old nurse? Sorry, we all need lots of freaking policies until we know what we are doing. A 2 year old nurse doesn't know a lot.

The implication to the post I was replying to is that Vaught wasn't at fault for not monitoring her patient because there apparently wasn't a policy about monitoring her patient.  My statement was that there doesn't need to be a policy in place for me to know that I need to monitor a patient after giving what I thought was a sedative.

[KalipsoRed21, BSN, RN]

FiremedicMike said:

The implication to the post I was replying to is that Vaught wasn't at fault for not monitoring her patient because there apparently wasn't a policy about monitoring her patient.  My statement was that there doesn't need to be a policy in place for me to know that I need to monitor a patient after giving what I thought was a sedative.

I caught what you meant. My point is that there are several things I have learned to do appropriately BECAUSE of policy and not just because it "makes sense to do so". 
It "makes sense" to monitor a patient when you are giving blood. But I have seen the policy be anything from the nurse has to be at bedside for 15 minutes then can leave to the patient has to have a nurse in the room the entire time the transfusion is going on plus 15 minutes afterwards. I have seen policies where you can't give blood without a tele monitor on the patient and ones that you HAVE TO have a tele monitor before you can transfuse. My point is, as a 2 year old nurse, in one facility, the standards of what is safe and practical are guided by whatever policies an institution has in place. Until one has had several years of experience and seen/ experienced several types of practices, one's "common sense" is not well developed. 

[Nurse Beth, MSN]

KalipsoRed21 said:

I caught what you meant. My point is that there are several things I have learned to do appropriately BECAUSE of policy and not just because it "makes sense to do so". 
It "makes sense" to monitor a patient when you are giving blood. But I have seen the policy be anything from the nurse has to be at bedside for 15 minutes then can leave to the patient has to have a nurse in the room the entire time the transfusion is going on plus 15 minutes afterwards. I have seen policies where you can't give blood without a tele monitor on the patient and ones that you HAVE TO have a tele monitor before you can transfuse. My point is, as a 2 year old nurse, in one facility, the standards of what is safe and practical are guided by whatever policies an institution has in place. Until one has had several years of experience and seen/ experienced several types of practices, one's "common sense" is not well developed. 

Policies protect nurses and patients. Common sense can be subjective.

[FiremedicMike, BSN, RN, EMT-P]

KalipsoRed21 said:

I caught what you meant. My point is that there are several things I have learned to do appropriately BECAUSE of policy and not just because it "makes sense to do so". 

It "makes sense" to monitor a patient when you are giving blood. But I have seen the policy be anything from the nurse has to be at bedside for 15 minutes then can leave to the patient has to have a nurse in the room the entire time the transfusion is going on plus 15 minutes afterwards. I have seen policies where you can't give blood without a tele monitor on the patient and ones that you HAVE TO have a tele monitor before you can transfuse. My point is, as a 2 year old nurse, in one facility, the standards of what is safe and practical are guided by whatever policies an institution has in place. Until one has had several years of experience and seen/ experienced several types of practices, one's "common sense" is not well developed. 

Lets get crazy for a minute - there is no policy at my facility that says I cant gouge out my patient's eyes with a pair of forceps just because I'm tired of them asking for pain medicine.  I can't just gouge someone's eyeballs out and then say "hey, not my fault, the hospital doesn't have a policy on that".

Obviously that scenario is reductio ad absurdum, but I think many of us would argue that monitoring a patient after giving an IV sedative is just about as blatantly obvious as that.

[Nurse Beth, MSN]

FiremedicMike said:

Obviously that scenario is reductio ad absurdum, but I think many of us would argue that monitoring a patient after giving an IV sedative is just about as blatantly obvious as that.

In lack of a policy and guidelines, individual nurses will each define "monitoring" differently, to the potential detriment of patient safety.

As an educator, I would not instruct a nurse to administer fentanyl/propofol/midazolam/dobutamine/nipride (examples)

and when asked how to monitor say "just use your common sense- we all do what we think is best here".